There’s life beyond Brexit, according to the U.K. government. No one else seems convinced.

Prime Minister Theresa May visited a hospital in Liverpool on Monday to lead a carefully choreographed announcement of the new 10-year plan for the National Health Service. Designed to show the government is capable of doing more than just leaving the EU, the plan aims to “save almost half a million more lives” in the next 10 years by focusing on prevention and making better use of digital health services.

With most domestic policy initiatives on hold because of Brexit, the government has promised a £20.5 billion spending boost by 2023-24 to back up its health plans — funds May said will come in part from the windfall to be enjoyed when the U.K. stops sending money to Brussels.

But the reactions from health care providers focused largely on the uncertainties facing the NHS ahead of Brexit, both in terms of finance and the departure of EU27 nationals that will worsen staffing issues. (Few believe a Brexit windfall is likely despite Vote Leave’s red bus.) Lengthening wait times for services was another politically sensitive issue set aside in the government’s announcement.

“This is not about miracles — money will be tight and staffing will remain a headache for years to come,” Niall Dickson, chief executive of the NHS Confederation, which represents health service providers, said in reaction to the plan. Warning of the risks of “over-promising,” Dickson said: “Our plea is that politicians be honest about the trade-offs that will be required and that we are realistic about what can be achieved given the ever-increasing demands of an aging population.”

Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity.

The announcement also suffered from the government’s strategy of pre-announcements: Major policy initiatives from new cancer screening to mental health service improvements had been widely previewed, leaving praise confined to celebrating the “vision” of tying those initiatives together.

1. Not enough money

Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity. The figure amounts to a 3.4 percent increase in funding, but think tanks such as the Nuffield Trust say at least a 4 percent boost is needed to “put the NHS on a sustainable footing.”

“Ultimately, there is a need for honesty about how far the £20.5 billion over five years will stretch,” British Medical Association (BMA) council Chair Chaand Nagpaul said Monday. “World-class care requires world-class funding and the investment in the long-term plan will still leave the U.K. falling behind comparative nations like France and Germany.”

Plus there’s concern a no-deal Brexit would deplete the promised funding — “the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks,” Nigel Edwards, chief executive of the Nuffield Trust, said in a statement.

Health Secretary Matt Hancock has promised the extra funds will be available “irrespective” of the outcome of Brexit talks with the EU, which doesn’t quite fit with May’s suggestion it will come in part from money London will no longer be sending to Brussels.

2. Staffing woes ignored

Staffing shortages are top of the list for nearly 60 percent of U.K. voters when asked where the extra NHS cash should be spent, according to a poll by the Times, but the government’s plan kicks that can down the road.

The plan promises “NHS staff will get the backing they need” by balancing “supply and demand across all staff groups.” The funding for hiring, training and professional development of NHS staff “has yet to be set by government” and won’t be published until “later in 2019,” it says.

The BMA, which represents doctors, and NHS Providers, which represents various NHS staff, cautioned the NHS will be hard-pressed to make good on the plan’s promises if it doesn’t improve the staffing situation. One in 11 posts are estimated to be vacant and the situation is predicted to worsen after Brexit, with the King’s Fund, the Health Foundation and the Nuffield Trust predicting a shortfall of around 250,000 NHS staff by 2030.

Nagpaul of the BMA said doctors and staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout.”

3. Hedging on waiting times

The government’s plan commits to reducing waiting times for mental health services across the board, ranging from children to adults and community-based care to crisis situations.

But as the NHS continues to come up short on waiting times for emergency care and routine surgery, the new plan offers no clear path forward other than to say “sufficient funds” will be allocated to local NHS services to cut long waits.

NHS chief Simon Stevens | Tolga Akmen/AFP via Getty Images

“We also need immediate, practical solutions and the necessary investment for hospitals to deliver both in the long- and short-term,” said Nagpaul of the BMA.

NHS chief Simon Stevens said there should be “tougher, faster” standards when it comes to emergency room waiting times in an interview with BBC Radio 4 on Monday, and suggested the existing four-hour guideline by which NHS progress is judged needs to be updated. “The problem with that is it doesn’t distinguish between turning up at A&E with a sprained finger and turning up with a heart attack,” he said. He declined to commit to specific targets.

4. Mixed messages on prevention

One of the main pillars of the government’s plan is prevention — stopping health problems before they start by trying to reduce smoking and drinking or increase exercise, for instance.

While many groups support this move, they couldn’t help but note the hypocrisy of the fact that government funding for local public health services has been cut in recent years. The latest projections are a cut of £85 million for 2019-20, to £3.1 billion.

“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again" — Nigel Edwards, chief executive of the Nuffield Trust

Nagpaul of the BMA urged the government to take bolder stances on issues such as a minimum unit price for alcohol and restricting sugar in food.

“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again,” said the Nuffield Trust’s Edwards.

5. Raised expectations

U.K. Chancellor Philip Hammond hit the nail on the head when he wrote in the Daily Mail on Monday: “The leaders of the NHS must now ensure they get the basics right. Alongside greater quality of care and ending waste, the public will demand that progress is made on the back of their investment.”

The widely touted funding rise will leave people expecting a better and more efficient NHS, which requires delivery on the basics such as wait times that the plan doesn’t address.

The government’s major targets are focused around specific diseases: The plan aims to prevent 150,000 heart attacks, strokes and dementia cases, and 55,000 cancer-related deaths, and help 380,000 more people get treatment for anxiety and depression. As Conservative Party MP and health select committee Chair Sarah Wollaston noted, some of the priorities mirror those set out in the previous five-year plan, “many of which remain unfinished business.”

“The last plan was undermined by the cuts to social care, public health, capital and training budgets and it is important not to see this repeated,” Wollaston wrote in a blog post.

Jacques Boote

The sooner the UK is away from these Anglophobic Nartsi;’s the better.

Posted on 1/7/19 | 8:01 PM CET

B B

The NHS is excellent for episodic illnesses but as shown by TM’s negotiations abysmal with chronic ailments like the EU! lol

Posted on 1/7/19 | 8:29 PM CET

Donal O'Brien

Att BB

@ B

Dear B

I must confess I arrived late to your little Battle outlining the Value of the English language with IT of the Many garters

But B their was no need to Hang, Draw and Quarter it in one Parry
Shur the poor DOPE is only finding ITS way against one who has crossed Swords with many Strewn on the Battle Field

Did it give me pleasure Yes
But Begorrah this glad I am, not to be at the End of that Flaying

You must still be disappointed that their was no Return still, as they say your performance

Beat BANAGHER and BANAGHER BEAT
the DEVIL

You’ll have to learn to restrain yourself
Shur their just MERE MORTALS

Cheers for Brexit
Allways
Donal O’Brien

Posted on 1/7/19 | 10:42 PM CET

Donal O'Brien

Att BB

Dear B

A quick 1
If you Jacq/Stan get a chance make sure you go to briefingforbrexit.com
And make sure you read up on Target 2
Will add to your all ready wide knowledge
It buts a whole different slant in the €40bil
Which that pal of mine was saying why they need that dough REAL BAD

Cheers for Brexit
Allways
Donal O’Brien

Posted on 1/7/19 | 11:00 PM CET

B B

@Donal O’Brien
“Donal O’Brien
Att BB

Dear B

A quick 1
If you Jacq/Stan get a chance make sure you go to briefingforbrexit.com
And make sure you read up on Target 2
Will add to your all ready wide knowledge
It buts a whole different slant in the €40bil
Which that pal of mine was saying why they need that dough REAL BAD”

Donal I shall do as instructed even if only to confirm what I already think. What I want to know is what does T May need so badly that caused her to get us nto this b—– mess. Any ideas?

Posted on 1/7/19 | 11:11 PM CET

B B

@Donal O’Brien
“You’ll have to learn to restrain yourself”

Oh dear me – the shame of it! Do I need to morph and get a new usernic? There was me thinking it was only a little verbal foreplay for mio dolce amore

Posted on 1/7/19 | 11:26 PM CET

Henry Jones

Don’t give enough money to do the job then blame the NHS for the disaster.

Posted on 1/8/19 | 12:59 AM CET

Patricia Wilson

Oy Trashy Treeza

That £20 billion is only £350 m a week for just over a year. What about after that?

Posted on 1/8/19 | 1:12 AM CET

Patricia Wilson

Donal

Ah so that’s where you get your inspiration from. Well I I never.

🙂

Nighty-night

Posted on 1/8/19 | 1:19 AM CET

Patricia Wilson

Donal/BB

Tut, tut. Reading comics at your age?

Ah well as they say here ‘Men may grow old but they never grow up’.

Tramp and Blow-Jo being prime examples.

🙂

Posted on 1/8/19 | 1:29 AM CET

Donal O'Brien

Att Comment

@ Balls de Bleu wilson p etc etc

I think the best thing a Dummy like you who Danced at the Cross Roads to quote a Great Pugilists

YOU WAS WHOPPED
Good and Proper so Clean your Glasses and go Back under your Stone

To finish will YA be using ANN or will it be ANN with an E either way TOUCHE to BB

Ha ha ha

You couldn’t make it UP

Cheers for Brexit
Allways
Donal O’Brien

i.e
By the way don’t forget to make 3 entrys for T Whale today ?
And Shur don’t be running in to Thank him for Turning up to Clear your Name
Where the F do ya think we where Born ?

Patricia Wilson

PS
Were you aware that the real Donal O’Brien or one of them is an Irish journalist?

Posted on 1/8/19 | 11:08 AM CET

Donal O'Brien

Att Comment

@ Balls de Bleu aka wilson p etc etc

Another Donal O’Brien ? are ya shure?
And de ya no I always taut der was JUST wan
Shur ya lern somen different odd days

Bet he has glasses like yourself ?

Are ya geten used to th Soap an Washer tis great to be geten Clene init

And you say a Journalists?

Well being a member of the Royal Family and not Dragged up like yourself to be a
Cute Whore I’m shure he must be a dacent fella

Do ya kon you nevr kan tell
Tis a an awful funny wold
wood ya agreen

By the way don’t forget to but in for your expenses
Now as theirs no Receipts required, have some respect for the European Tax Payer

like FK

Cheers for Brexit
Allways
Donal O’Brien

Posted on 1/8/19 | 12:40 PM CET

B B

@Patricia Wilson
“Ah well as they say here ‘Men may grow old but they never grow up’.”

Personally I prefer something a little more highbrow like the Ballard of Eskimo Nell.

Posted on 1/8/19 | 6:09 PM CET

B B

@Donal O’Brien
I feel sure you know what Alan Greenspan thinks of Target 2 and the Euro but thought it might be of interest to those who may have missed it.

There’s one thing that bothers me considerably, which nobody makes any mention of. There is in the European Central Bank a mechanism as it exists of necessity where the European Central Bank is made up of the central banks of the European, euro area and there’s a thing called Target2, do you know what Target2 is?

Target2 at this particular stage is turning out to be an extraordinary large transfer from Bundesbank to essentially Italy and Spain, and most recently the European Central Bank. That means the Bundesbank is lending money to the European Central Bank and the question is – it’s big numbers. We’re talking 7,800 billion euro.

Something is going to happen there. My view is it’s either going to be Greece – it conceivably could be Italy. […] but it is extraordinary what is going on in this system while the total assets of [the] European Central Bank continue to go straight up. What would happen if there was a default of the euro?

In the United States, if there were a default on the dollar the US Treasury could always [step in]. For example, if the federal reserve went into default the US Treasury would bail it out but what [European countries] do? There is no comparable vehicle to help the system.

Target2 exposes the fatal flaw of the eurozone
The eurozone has a very complex monetary and banking system. Because it wasn’t designed from the ground up, but evolved from a long list of countries being shoved in together, largely against the will of their people, the system is a bit odd.

It also has a fatal flaw, which we’ll get to in a moment. Each time this flaw leads to a problem, the europhiles add a layer of complexity to cover up the symptoms. But failing to address the underlying cause just creates new problems. Problems like Target2.

Target2 is the system by which the various European central banks, the European Central Bank (ECB) and Europe’s commercial banks interact. They settle large transfers of funds using the Target2 system.

The key players are the German Bundesbank, the French Banque de France and Italy’s Banca d’Italia. Nineteen other central banks are involved, plus four from outside the eurozone. The Bank of England doesn’t participate.

What can be wrong with a payment system? Greenspan mentioned it above. The transfer of funds seems to be steadily going one way. Out of German hands and into southern European.

This chart from Yardeni Research shows how Germany, in purple, is financing Spain and Italy, in green and teal:

Source: Yardeni Research

The Germans see this as an enormous risk. They could be the ones left empty handed when southern Europe defaults.

The southern Europeans resent the German dominated credit market. German lenders decide who gets to borrow and who doesn’t.

The Target2 system’s imbalances expose the eurozone as the monetary version of George Orwell’s Animal Farm. They show who is paying to keep the eurozone afloat and who is living off other people’s money. And the figures far outweigh any contributions to the EU budget or other transfers.

But the system has to function to keep the euro system alive. So if it sputters or fails completely, that would have enormous consequences for Germany too. Especially given its export-oriented economy sends goods to southern Europe.

If you think all this is a bit obscure, you’re simply wrong. The Target2 imbalance already triggered legal challenges and political campaigns in Germany. An extraordinarily popular book explained how the Target2 “trap” poses an immense risk to German “money and our children”. And the Bundesbank took the ideas seriously enough to try and refute them.

Europe’s institutions and leaders ensure us that the system does not pose any risk because of its features. But that’s nonsense because it’s the failure of the system that everyone is worried about.

But how did this dreadful imbalance develop in the first place?

The fatal flaw of the eurozone
Even if central bankers’ motivations were as pure as Greenspan suggested, and their wisdom as infinite as they project, don’t forget that monetary policy is responsible for the financial crisis of 2008.

In the US, the Federal Reserve and Greenspan copped some of the criticism they deserved. Many commentators now agree that interest rates were kept too low for too long in the 2000s, inflating the housing bubble.

But in Europe, the ECB’s one-size-fits-all monetary policy was never blamed for the housing bubbles in Ireland and Spain. Those countries should’ve had higher interest rates when their property markets boomed. But Germany’s economy was the “sick man of Europe” at the time, requiring low interest rates. This financed the housing bubble’s excesses in the peripheral countries.

It’s hard to deny this given the precise opposite has happened since. Germany is now benefiting from interest rates that are far too low for its booming economy. But the ECB can’t raise rates on the struggling Italians and Greeks.

This is the fatal flaw of the eurozone. One monetary policy for all those different countries means the wrong interest rate applies everywhere.

Some countries are getting money too cheaply, growing housing and debt bubbles. While for others, the same monetary policy is too tight. Over time, this is leading to enormous anti-euro sentiment and economic instability. Not a good combination.

How does all this break down? There are two possible ways.

The first is politics. Political parties that are eurosceptic and anti-euro could be elected to parliaments around Europe, forcing change. That’s process is well underway. The Italian elections in a month will be the key.

But my friend Charlie Morris is expecting something a little different. He thinks a change in the tides of money is about to upset the balance in the world’s most important financial markets. And if he’s right, it’ll be enough to sink the EU and the euro as we know it.

If anyone wishes to go to the source:
“https://www.capitalandconflict.com/end-of-europe/target2-exposes-the-fatal-flaw-of-the-eurozone/”